Homestead_Hipp � ,r_q CLAIM FOR HOMESTEAD PROPERTY TAX L
FORM I YEAR
d STANDARD/SUPPLEMENTAL DEDUCTION
�� • Slate Form 5473(Rta I 1-20) HC1 O I 2022
y- Prescribed by the Department of Local Government Finance
INSTRUCTIONS.See reverse side for filing/nstrucUons.
NOTE:Telephone,Social Securely,driver's license,state idenll/icadon and federal Identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Tony 8 Judy Hipp certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under conirac for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed,Apr`1 1 --11 na.. (date of signature). I(We):
1 Own. El Ant(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
, _
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CONTRACT RECORDED
I buying on contract.Fee 91mple coney.name
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Recorders office where cent/eel Is recorded Record number Page 9r^^, ,es,6,
PROPERTY DESCRIPTION 8 '6
County Township Taxing district trip town.formable) ' 49 v
Gibson Johnson Johnson sv._ O�i'
Parcel number Legal description Is the property in question'26
Q Real property El Annually assessed mobile home( f r L
.ny23-17o200-000.637-024 PT W NE 17 4 10e 18.88creAC -/gyp 4(`4\!�l
If any penwn of we re.idenu.l.wclvr.a the land not exceeding one Cr)acre Bel immediately surrounds that structure u used a produce Irrmorts,describe the use and peel O
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of the propertyubiiied to produce Income. /rO 4,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,end Township Is claimant vacating a homestead?
0 Yes 8 No
Signature of WI
I
hereby certify the above statements ere Irue.correct,and complete.
Address or contact(number and sheet,city,slate,and ZIP code) Address of vacated h lead.a any(number and ,city Nate,end ZIP cos)
12254 S US Hwy 41.Haubstadt,IN 47639
ASSESSOR USE Obit Y ASSESSED VAI.OF HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
ku'r'rod rosid ntlai Improvemenbdlatsiy (1)
Other land (2)
Total land(fine 1 plus line 2) (1)
Residential Improvement.or I Dwelling (4)
annually assessed mobile I
manufactured home Garage (5)
Other Improvements (6)
Total Improvements(line 4 through One 6) (7)
Total value (line 3 plus Iln.7) (a)
I hereby certify the above le true,correct, Signature of Assessor Date signed(month,day.year)
and complete.
Verifying action-Signature of Auditor Dale signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE.
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwlthshending any other provision,the sum of the deductions provided in IC 6-1./-12 to a mobile horns S
that is not assessed as real property or to a manufactured home that is not assessed es real property may
not exceed one-hell(1R)of the assessed value of the mobile home or manufactured home.
Signature of Auditor I
Dale Waned...Wendt day year)
DISTREBUTION:Origin.]-County Auditor.FlM.Stamped Copy•Tespayer
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